Bottom Line:
Of these incidental PCas, 57.1% (20.8% of all patients undergoing CPT) were clinically significant.Incidental PCas were diagnosed in ∼40% of CPT specimens, and ∼50% of incidental PCas were clinically significant.During radical CPT in patients aged ≥60 years, the possibility of the presence of PCa and the potential oncologic risk of partial prostatectomy during CPT should be remembered.

Purpose: To determine the incidence and clinical features of incidentally discovered prostate adenocarcinoma in patients undergoing radical cystoprostatectomy (CPT) for bladder cancer.

Methods: Ninety-six consecutive patients scheduled to undergo CPT were prospectively enrolled. The prostates were excised completely during CPT. The CPT specimens were examined, and the clinicopathologic characteristics of incidental prostate cancer studied. Complete transverse sections of the prostate were taken from the apex to the base at 4-mm intervals and all prostates were examined by a single pathologist.

Results: The mean patient age and prostate-specific antigen level were 66.1 ± 10.0 years and 2.8 ± 5.0 ng/mL, respectively. Of the 96 patients, 35 (36.5%) had prostate cancer (PCa). Of these incidental PCas, 57.1% (20.8% of all patients undergoing CPT) were clinically significant. None of the patients who were age ≤50 years had incidental PCa. However, the incidences of PCa in the 51-60 years, 61-70 years, and ≥71 years age groups were 27.8% (5/18), 48.7% (19/39), and 35.5% (15/31), respectively, and the difference according to the age subgroup was significant (P = 0.048). During the median follow-up of 49 months, 29.2% (28/96) of patients died. There were no PCa-specific deaths, and two patients (2.1%) showed biochemical recurrences.

Conclusion: Incidental PCas were diagnosed in ∼40% of CPT specimens, and ∼50% of incidental PCas were clinically significant. During radical CPT in patients aged ≥60 years, the possibility of the presence of PCa and the potential oncologic risk of partial prostatectomy during CPT should be remembered.

fig1: Overall survival of patients. Patients (A) with or without incidental prostate cancer and (B) with or without clinically significant prostate cancer (PCa) in the cystoprostatectomy specimens. CPT, cystoprostatectomy.

Mentions:
Follow-up data were available for all of the 96 patients who underwent CPT. Median follow-up period was 49.0 months after CPT (range, 10.0–90.0 months). Twenty-eight deaths had occurred by the time of analysis; 26 patients died of bladder cancer progression; and two patients died of other conditions. However, there were no PCa-specific deaths. The Kaplan–Meier survival curve showed that the presence of PCa (significant or not) was not associated with risk of mortality after CPT (Fig. 1). Except for one patient, almost all of the patients (30/31, 96.8%) with incidental PCa had undetectable serum PSA levels at 3 months after CPT. During the follow-up period, two of the 30 patients experienced a biochemical recurrence.

fig1: Overall survival of patients. Patients (A) with or without incidental prostate cancer and (B) with or without clinically significant prostate cancer (PCa) in the cystoprostatectomy specimens. CPT, cystoprostatectomy.

Mentions:
Follow-up data were available for all of the 96 patients who underwent CPT. Median follow-up period was 49.0 months after CPT (range, 10.0–90.0 months). Twenty-eight deaths had occurred by the time of analysis; 26 patients died of bladder cancer progression; and two patients died of other conditions. However, there were no PCa-specific deaths. The Kaplan–Meier survival curve showed that the presence of PCa (significant or not) was not associated with risk of mortality after CPT (Fig. 1). Except for one patient, almost all of the patients (30/31, 96.8%) with incidental PCa had undetectable serum PSA levels at 3 months after CPT. During the follow-up period, two of the 30 patients experienced a biochemical recurrence.

Bottom Line:
Of these incidental PCas, 57.1% (20.8% of all patients undergoing CPT) were clinically significant.Incidental PCas were diagnosed in ∼40% of CPT specimens, and ∼50% of incidental PCas were clinically significant.During radical CPT in patients aged ≥60 years, the possibility of the presence of PCa and the potential oncologic risk of partial prostatectomy during CPT should be remembered.

Purpose: To determine the incidence and clinical features of incidentally discovered prostate adenocarcinoma in patients undergoing radical cystoprostatectomy (CPT) for bladder cancer.

Methods: Ninety-six consecutive patients scheduled to undergo CPT were prospectively enrolled. The prostates were excised completely during CPT. The CPT specimens were examined, and the clinicopathologic characteristics of incidental prostate cancer studied. Complete transverse sections of the prostate were taken from the apex to the base at 4-mm intervals and all prostates were examined by a single pathologist.

Results: The mean patient age and prostate-specific antigen level were 66.1 ± 10.0 years and 2.8 ± 5.0 ng/mL, respectively. Of the 96 patients, 35 (36.5%) had prostate cancer (PCa). Of these incidental PCas, 57.1% (20.8% of all patients undergoing CPT) were clinically significant. None of the patients who were age ≤50 years had incidental PCa. However, the incidences of PCa in the 51-60 years, 61-70 years, and ≥71 years age groups were 27.8% (5/18), 48.7% (19/39), and 35.5% (15/31), respectively, and the difference according to the age subgroup was significant (P = 0.048). During the median follow-up of 49 months, 29.2% (28/96) of patients died. There were no PCa-specific deaths, and two patients (2.1%) showed biochemical recurrences.

Conclusion: Incidental PCas were diagnosed in ∼40% of CPT specimens, and ∼50% of incidental PCas were clinically significant. During radical CPT in patients aged ≥60 years, the possibility of the presence of PCa and the potential oncologic risk of partial prostatectomy during CPT should be remembered.